In December 2016, the first federally comprehensive report on e-cigarettes was presented by the Surgeon General. The presentation reported e-cigarettes as an emerging public health threat for youth and young adults. Since 2011, and the beginning of e-cigarette surveillance by the National Youth Tobacco Survey, e-cigarettes have surpassed traditional cigarettes as the most popular tobacco product among youth and young adults, but not without concern. E-cigarettes, also known as electronic nicotine delivery systems, deliver nicotine to the body through inhaled, aerosolized vapor. This aerosol typically includes nicotine, chemical flavorings, and additional additives. Conclusions from the Surgeon General’s report find that there is no safe level of nicotine exposure for youth and young adults. The health effects of nicotine on the developing brain include interruption of the growth of brain circuits that control attention, learning, and susceptibility to addiction. Exposure to nicotine also has the ability to prime the developing brain for addiction to other drugs, such as methamphetamine and cocaine. The use of e-cigarettes by pregnant women is also of concern. Nicotine can cross the placenta and impact the fetus. Some constituents in e-liquids include known carcinogens, but the adverse health effects of all constituents in e-cigarette aerosol is still unknown. E-cigarette vapor is not just “water vapor” as once commonly believed. Further research called upon by the Surgeon General aims to identify these health effects. Accidental ingestion of e-liquid poses additional risks. Ingestion of nicotine can lead to acute toxicity and possibly death, if consumed.

In 2015, it was found that 16.0% of high school students and 5.3% of middle school students currently use e-cigarettes. The rates of use among middle and high schools students is greater than that of young adults (18-24 years of age) and adults (≥ 25 years of age). Since 2011, the rate of current use among middle and high school students has more than tripled. The rate of current use among young adults has also more than doubled from 2013 to 2014. There is also an association between e-cigarette use among youth and the use of other tobacco products, but further research is needed to determine if that is a cause-and-effect relationship. 58.8% of high school students that currently use combustible tobacco products, such as cigarettes, are also current users of e-cigarettes. Youth and young adults report they use e-cigarettes because of the flavorings and lower perceived risk compared to other tobacco products.

The Surgeon General recommends numerous interventions at federal, state, local, tribal, and territorial levels to help reduce the prevalence of e-cigarette use among youth and young adults. These interventions include incorporating e-cigarettes into smoke-free policies, preventing access to youth, increases in price and taxes on e-cigarettes, requiring retail outlets to become licensed, regulation of e-cigarette advertising, increasing research of e-cigarettes, and educational initiatives that target youth. These interventions have helped to reduce the prevalence of cigarette smoking in the nation from over 40% in 1964 to around 15% today.